NEPH-ROSIS (NEPHrology in CirRhOSIS) Pilot Trial: A Trial to Treat Acute Kidney Injury Among Hospitalized Cirrhosis Patients

University of California San Francisco (UCSF)

Status and phase: Terminated; Phase 3; Phase 2

Conditions: Portal Hypertension; Acute Tubule Necrosis; Cirrhosis; Acute Kidney Injury; Hepatorenal Syndrome; Prerenal Failure

Treatments: Drug: MAP-Target Algorithm

Study type: Interventional

Funder types: Other

Identifiers

NCT06000748

23-39806

Details and patient eligibility

About

The goal of this pilot, randomized, single-blind clinical trial is to estimate the effect size of a high and low mean arterial pressure (MAP)-target algorithm among cirrhosis patients hospitalized with acute kidney injury. The main aims to answer are: • Does an algorithm that has low (<80 mmHg) and high (≥80) MAP-targets lead to significant differences in mean arterial pressure? • Are there any serious adverse events (e.g., ischemia) in a high blood pressure algorithm as compared to a low blood pressure algorithm? • Are there any differences in the incidence of AKI reversal in the high v. low MAP-target groups? Participants will be: 1) Randomized to a clinical algorithm that will either target a low (<80 mmHg) or high (≥80 mmHg) MAP. 2) Depending on their group, investigators will titrate commonly used medications to a specific MAP target. Researchers will compare the high and low MAP-target groups to see if these algorithms lead to significant changes in MAP, if they have any impact on AKI reversal, and if there are any adverse events in the high MAP-target group.

Enrollment: 6 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Hospitalized patients with decompensated cirrhosis, defined as a Child-Pugh Score ≥ 7
• Acute Kidney Injury: a ≥50% increase in sCr from an outpatient baseline sCr measured 7 to 365 days prior to admission

Exclusion criteria

1. Patients without a baseline (7 - 365 days prior to AKI development) sCr measurement;
2. Patients who are already on kidney replacement therapy (KRT) at the time of enrollment;
3. Patients with an oxygen requirement greater than 6L via nasal cannula;
4. Patients with a serum creatinine level exceeding 5 mg/dL.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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6 participants in 2 patient groups

Low MAP-Target

Active Comparator group

Description:

This group will be randomized to a treatment algorithm that utilizes a low MAP-target (\<80 mmHg) to determine if titration of vasoconstrictors is needed.

Treatment:

Drug: MAP-Target Algorithm

High MAP-Target

Active Comparator group

Description:

This group will be randomized to a treatment algorithm that utilizes a high MAP-target (≥80 mmHg) to determine if titration of vasoconstrictors is needed.

Treatment:

Drug: MAP-Target Algorithm